Open surgery in the treatment of patients with hilar cholangiocarcinoma: a study on curative efficacy and prognostic factors / 中华肝胆外科杂志

Objective:To study the efficacy of different surgical methods in treatment of hilar cholangiocarcinoma (HCCA), and to analyze the factors affecting long-term prognosis of HCCA patients after surgical treatment.Methods:The clinical data of 105 patients who underwent surgical treatment for HCCA at the First Affiliated Hospital of Soochow University from April 2010 to October 2021 were retrospectively analysed. There were 58 males and 47 females, with age (64.2±10.6) years old. Data analysed included surgical treatments, postoperative pathological data, perioperative complications and survival on follow-up. The Kaplan Meier survival curve was plotted, and the log-rank test and Cox proportional hazard model were performed to analyze the key factors affecting long-term prognosis.Results:Of 105 patients, 4 (3.8%) patients died during the perioperative period, and 58 patients (55.2%) developed complications with included 32 (30.5%) patients with pleural effusion and 12 (11.4%) patients with biliary leakage. The follow-up data was available in 85 patients with the overall median survival time of 19 months, and the 1-, 3-, 5-year cumulative survival rates of 58.1%, 27.0% and 24.8% respectively. The 1-, 3-, and 5-year cumulative survival rates for the R 0 resection patients ( n=59) were 69.4%, 36.2%, 27.4%, respectively, which were significantly better than 49.4%, 12.3%, 0% for the R 1/2 resection patients ( n=20), and 0% for the palliative drainage patients ( n=6) (all P<0.05). Univariate analysis and Cox multivariate analysis showed that age ≥70 years ( HR=2.158, 95% CI: 1.175-3.965), preoperative CA19-9 level ≥1 015 U/ml ( HR=1.981, 95% CI: 1.009-3.894), resection margin ( HR=2.587, 95% CI: 1.371-4.881), and lymph node metastasis ( HR=2.308, 95% CI: 1.167-4.567) were independent risk factors for long-term prognosis of HCCA patients (all P<0.05). Conclusions:R 0 resection was an effective way to prolong survival of patients with HCCA. Age, preoperative CA19-9 level, resection margin and lymph node metastasis were related to long-term survival of HCCA patients.

Pirfenidone alleviates urethral stricture following urethral injury in rats by suppressing TGF-β1 signaling and inflammatory response / 南方医科大学学报

OBJECTIVE@#To investigate the effect of pirfenidone for reducing urethral stricture following urethral injury in rats and explore the possible mechanism.@*METHODS@#Thirty male SD rats were randomly assigned into negative control group, positive control group and pirfenidone group (n=10). In pirfenidone and positive control groups, the rats were subjected to incision of the posterior urethral cavernous body followed by daily intraperitoneal injection of pirfenidone (100 mg/kg) and an equivalent volume of solvent, respectively. The rats in the negative control group were given intraperitoneal injections of solvent without urethral injury. At two weeks after modeling, retrograde urethrography was performed for observing urethral stricture, and the injured urethral tissues were harvested for HE staining, Masson staining, immunohistochemical staining and Western blotting for detecting the protein expressions of α-SMA and TGF-β1. The mRNA expressions of the inflammatory factors TNF-α, IL-6, and IL-1β were detected using qRT-PCR.@*RESULTS@#The body weight of the rats in pirfenidone group was significantly decreased compared with that in the other two groups (P < 0.05). Retrograde urethrography showed significant narrowing of the urethra in the positive control group but not in the pirfenidone group. HE staining of the injured urethral tissues showed obvious proliferation of urethral epithelial cells with narrow urethral cavity and increased inflammatory cells in positive control group. The pathological findings of the urethra were similar between pirfenidone group and the negative control group. Masson staining revealed obviously reduced collagen fibers and regular arrangement of the fibers in pirfenidone group as compared to the positive control group. Compared with those in the negative control group, the expressions of α-SMA and TGF-β1 were significantly increased in the positive control group, and pirfenidone treatment significantly inhibited their expressions (P < 0.05 or 0.01). Pirfenidone also significantly inhibited the mRNA expressions of TNF-α, IL-6, and IL-1β in the injured urethral tissue (P < 0.05 or 0.01).@*CONCLUSION@#Pirfenidone can prevent urethral fibrosis and stricture after urethral injury possibly by inhibiting the TGF-β1 pathway and inflammatory response.

The diagnosis and risk factors for postoperative acute pancreatitis following pancreaticoduodenectomy / 中华普通外科杂志

Objective:To study factors associated with postoperative acute pancreatitis (POAP) in patients following pancreaticoduodenectomy.Methods:This retrospective analysis included 60 patients who underwent pancreaticoduodenectomy at the First Affiliated Hospital of Soochow University from Jan 2020 to Aug 2021. Enhanced computed tomography was used to identify POAP during postoperative period of 4 to 9 days. Univariate analysis and multivariate analysis were used to find out the risk factors of POAP.Results:Of the 60 patients, 13 cases (21.7%) developed POAP. The incidence of clinically related pancreatic fistula with abdominal abscess (76.9% vs.19.1%, χ2=15.71, P<0.000 1), postoperative hospital stay (26 d vs. 18 d, U=141.5, P=0.002 5) and the severity of complications (Clavien-Dindo grade≥Ⅲ: 53.8% vs. 21.3%, χ2=5.32, P=0.02) were significantly higher in the POAP group. But there was no significant deviation between the two groups when it comes to the severe post pancreatectomy delayed hemorrhage (7.7% vs. 0, χ2=3.68, P=0.06) and the delayed gastric emptying (30.8% vs. 21.3%, χ2=0.51, P=0.47). In the univariate analysis, patients with higher body mass index ( P=0.000 3), smaller main pancreatic duct diameter ( P<0.000 1) and softer texture of the pancreas ( P=0.009) were more likely to develop POAP after pancreaticoduodenectomy. In the multivariate analysis, the pancreatic duct diameter≤2 mm ( OR=0.005,95% CI 0.000 06-0.44, P=0.020), the softer texture of pancreas ( OR=0.005, 95% CI 0.000 04-0.47, P=0.023) were risk factors for POAP. Conclusions:Patients with postoperative acute pancreatitis increased the incidence of pancreatic fistula complicating abdominal abscess.Small caliber pancreatic tube, soft texture of pancreas were risk factors of POAP.

Efficacy and safety of radium-223 in the treatment of metastatic castration resistant prostate cancer / 中华泌尿外科杂志

Objective:To analyze the efficacy and safety of radium-223 in the treatment of metastatic castration resistant prostate cancer (mCRPC).Methods:The clinical data of 22 patients with mCRPC treated with radium-223 in the Chongqing University Cancer Hospital from January 2021 to January 2022 were analyzed retrospectively. The average age was (70.7±1.3)years old. There were 7 cases with ECOG score of 1 and 15 cases with ECOG score of 2. There were 7 cases with grade 2 and 15 cases with grade 3 bone metastasis. For mCRPC, 1 case (4.6%) received first-line treatment, 4 cases (18.2%) received second-line treatment, 10 cases (45.5%) received third-line treatment, 4 cases (18.2%) received fourth-line treatment, and 3 cases (13.6%) received fifth-line treatment. The median time from the diagnosis of mCRPC to the start of radium-223 treatment was 29 (20, 34) months. Radium-223 (55kbq/kg) was injected intravenously every 4 weeks for up to 6 cycles. Before treatment, the median alkaline phosphatase (ALP) was 147.0 (101.8, 212.5)U/L, the median prostate specific antigen (PSA) was 44.7(20.2, 99.1)ng/ml, and 6 patients (27.3%) were complicated with grade 1-2 anemia. The median hemoglobin was 115.0 (103.8, 122.5) g/L, the average neutrophil was (3.0 ± 0.3)×10 9/L, and the average platelet was (169.8 ± 17.0)×10 9/L. The overall survival (OS), radiographic progression-free survival time (rPFS), time to PSA progression, PSA response rate, pain response rate, and time to pain progression were analyzed. Stratified analysis was carried out according to the number of treatment lines experienced before radium-223 treatment. At the same time, the main adverse reactions during radium-223 treatment were analyzed. Results:The mean number of treatment courses with radium-223 was 2.7(ranging 1 to 6), with 4 patients completing 6 courses, 12 (54.6%) completing ≥ 3 courses, and 10 (45.5%) completing < 3 courses. Thirteen patients (59.1%) were treated with radium-223 alone and 9 (40.9%) in combination with other treatments (1 of docetaxel chemotherapy, 2 of enzalutamide, 3 of olaparib, and 3 of estramustine phosphate). None of the patients in this group were treated with bisphosphonates. Ten patients (45.5%) in this group died, all due to disease progression. The median overall survival time of the 22 cases was 11.0 (2.2, 19.8) months. Three patients (13.6%), 7 patients (31.8%), 3 patients (13.6%), and 1 patient (4.5%) showed radiographic progression at 2, 3, 4, and 10 months after treatment, respectively, while the remaining 8 patients (36.4%) did not show radiographic progression during the follow-up period, and the median radiographic progression free time for the 22 patients was 4.0 (3.1, 4.9) months. There were four cases (18.2%) showed PSA response, of which three cases (13.6%) showed PSA rising again later, and one case (4.5%) showed continuous PSA decline. The median time to PSA progression for the 22 patients was 3.6 (2.2, 5.1) months. Fifteen patients (68.2%) experienced pain response at 1 month of treatment, of whom 5 (22.7%) experienced increased pain later and 10 (45.5%) experienced sustained pain relief. The median time to pain progression was 5.5 (3.5, 7.6) months in 22 patients. No patients received radiotherapy or surgery for pain, and no patients experienced fracture. In this group, 7 patients (31.8%) had a post-treatment ALP decrease ≥30% from baseline. Major adverse events during radium-223 treatment were all grade 1 to 2 events, no grade ≥3 adverse events, and no treatment discontinuers due to adverse events.Conclusions:Radium-223 resulted in high pain response rates and prolonged OS, rPFS and time to PSA progression in patients with mCRPC. Adverse effects were low during treatment. The conclusions need to be validated by further expansion of the sample size and extended follow-up.

Diagnosis and treatment of emergency inguinal hernia / 中华消化外科杂志

Objective:To investigate the diagnosis and treatment of emergency inguinal hernia.Methods:The retrospective cross-sectional study was conducted. The clinical data of 236 patients with emergency inguinal hernia who were admitted to the First Affiliated Hospital of Soochow University from January 2015 to May 2020 were collected. There were 194 males and 42 females, aged (69±30)years. Hospitalized patients received routine blood biochemistry test and imaging examinations for evaluation of characteristics of hernia contents and intestinal obstruction. Manual reduction and surgical treatment were selected according to the conditions of patients. Observation indicators: (1) treatment; (2) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect hernia recurrence and late-onset mesh infection up to August 2020. Measurement data were described as M (range) or M ( P25, P75), and comparison between groups was analyzed using the Wilcoxon rank sum test. Count data were represented as absolute numbers, and comparison between groups was done using the chi-square test. Results:(1) Treatment: of the 236 patients, 106 cases had successful manual reduction, 124 cases underwent emergency operation, 6 cases refused surgery. ① For 106 cases with successful manual reduction (including 4 cases guided by B-ultrasonography), the manual reduction time was 5 minutes (2 minutes,7 minutes). Ninety-three of 106 patients underwent selective operation after manual reduction, including 89 cases with indirect hernia, 2 cases with direct hernia and 2 cases with compound hernia. The time to selective operation was 3 days(2 days,5 days) after manual reduction. Patients underwent mesh repair, of which the operation time, volume of intraoperative blood loss, time to postoperative first flatus, duration of postoperative hospital stay were 44 minutes (29 minutes, 66 minutes),10 mL(5 mL,20 mL), 1 day(1 day,2 days), 1 day(1 day,2 days), respectively. Eleven patients didn't undergo selective operation. Two patients with abdominal pain and fever after manual reduction were diagnosed with perforation of intestine by emergency surgical exploration, and then underwent partial intestinal resection combined with high ligation of hernial sac. ② There were 93 of 124 patients undergoing emergency operation with indirect hernia, 18 cases with femoral hernia, 6 cases with obturator hernia, 6 cases with compound hernia and 1 case with direct hernia. There were 54 of 124 patients undergoing open operation, including 21 cases with Bassini surgery, 18 cases with Lichtenstein surgery, 9 cases with Mc Vay surgery, 6 cases with high ligation of hernia sac. There were 70 patients undergoing laparoscopic operation, including 57 cases with laparoscopic transperitoneal preperitoneal hernia repair (TAPP), 10 cases with laparoscopic explora-tion + tissue repair and 3 cases with laparoscopic exploration + closure of inner inguinal ring. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, cases with short-term postoperative complications were 60 minutes (50 minutes,76 minutes), 20 mL(14 mL,30 mL), 2 days(1 day,2 days), 15 cases for patients undergoing open surgery, respectively. The above indicators were 56 minutes (47 minutes,77 minutes), 20 mL(10 mL,25 mL), 2 days(1 day,2 days), 21 cases for patients under-going laparoscopic surgery. There was no significant difference in the above indicators between the two groups ( Z=?0.88, ?1.37, ?1.56, χ2=0.07, P>0.05). Cases with intraoperative placement of mesh and duration of hospital stay were 18 cases and 5 days(3 days,8 days) for patients undergoing open surgery, versus 57 cases and 3 days(2 days,5 days) for patients undergoing laparoscopic surgery, showing significant differences between the two groups ( χ2=29.50, Z=?4.32, P<0.05). (2) Follow-up: of 236 patients, 192 were followed up for 2?60 months, with a median follow-up time of 19 months. Seven patients had recurrence of hernia after emergency operation, including 3 with high ligation of the hernia sac, 2 with Bassini surgery, 1 with Lichtenstein surgery, and 1 with laparoscopic exploration + closure of inner inguinal ring. One patient with late-onset mesh infection after Lichtenstein surgery was improved after mesh removal. No long-term complications such as hernia recurrence or late-onset mesh infection occurred to the 184 patients. Conclusions:Emergency inguinal hernia had different state of illness, manual reduction is suitable for partial patients with incarceration. Surgery is the first choice, and the surgical procedure needs to be individually selected.

The effect on nicotine addiction of combining transcranial magnetic stimulation with smoking-related cues / 中华物理医学与康复杂志

Objective:To explore the effect of repetitive high-frequency magnetic stimulation (H-F rTMS) of the dorsolateral part of the prefrontal cortex (DLPFC) combined with smoking-related cues on nicotine addicts′ cigarette craving, the concentration of exhaled CO and sleep quality.Methods:Sixty nicotine addicts were randomly divided into groups A, B and C, each of 20. All were given H-F rTMS five times a week for two weeks, while those in groups A and B watched smoking and non-smoking pictures for ten minutes, respectively. Before and after the intervention, all of the subjects self-reported their cigarette cravings using a visual analogue scale. Exhaled CO (CO ppm) was measured and the Pittsburgh sleep quality index (PSQI) was evaluated. Results:After the intervention the average craving score, CO ppm and PSQI score had improved significantly in all three groups. The average craving score and CO ppm of group A were both significantly better than in the other two groups. Conclusions:rTMS can significantly improve cigarette craving, CO ppm and sleep quality of cigarette adicts. Viewing smoking-related pictures as an addition to rTMS can even better the effects of rTMS.

Clinical characteristics and experience for the diagnosis and surgical treatment of abdominal cocoon / 中华普通外科杂志

Objective:To investigate the clinical characteristics and treatment of the abdominal cocoon.Mehods:The clinical data of 28 patients with abdominal cocoon from Jan 2004 to Dec 2018 were analyzed retrospectively.Results:Intestinal obstruction was the main clinical manifestations (25 cases), recurrent chronic ileus(17 cases) and abdominal mass (7 cases). Preoperative imaging examination showed varying degrees of intestinal obstruction. CT or MRI scan displayed that small intestinal loops were disorganized , clustered and encased in a thickened capsule. All the cases underwent operations, showing that small bowel were encapsulated in a dense gray-white fibrous membrane. Adhesiolysis and fibrous membrane excision were done with segmental enterectomy when it was necessary. Early postoperative intestinal obstruction occured in 6 cases, all were cured by conservative treatment.Conclusions:The combination of clinical symptoms and CT or MRI may facilitate in preoperative diagnosis. Abdominal cocoon is putative diagnosis when recurrent intestinal obstruction with abdominal mass. Surgery is the therapy of choice.

A standardized laparoscopic left lateral sectionectomy in liver resection / 中华肝胆外科杂志

Objective A retrospective analysis was conducted on standardized laparoscopic left lateral sectionectomy in liver resection (LLLR) using the "Two Step Two Endo-GIA" procedure.The aim of the study was to improve safety and efficacy of the operation.Methods All patients who underwent LLLR in Department of General Surgery,the First Affiliated Hospital of Soochow University from May 2014 to July 2018 were included in the study.All patients were divided into laparoscopic group (n=56) and open group (n=44).The operative plan followed the standardized procedure used in our department.Results Of 56 patients,there were 28 males and 28 females.No hepatic hilar occlusion was required and no case was converted to laparotomy.The average age was (55.7± 13.0),tumor diameter (6.3±3.7) cm,liver dissection time (30.0± 10.9) min,intraoperative blood loss (142.3±22.8) ml,and postoperative length of hospital stay (6.1±2.4) d.The average follow-up was (36.6± 10.1) months.One patient developed mild bile leakage and recovered after drainage.The other patients had no serious postoperative complications.The laparoscopic group was superior to the open group in operation time (90.0±17.0 vs.129.3±38.8) min,fasting time (1.5±1.0 vs.2.1±1.1) d,TBil (13.0±2.6 vs.19.0±3.1) μmol/L and ALT (80.0±19.3 vs.200.0±32.1) U/L.Conclusion A standardized LLLR has the advantages of short operation time,good reproducibility and short learning curve.It can be used as a standard procedure at all hospital levels.

Analysis of structural features of gut microbiota in two-kidney-one-clip hypertensive rats based on high-throughput sequencing technology / 中华心血管病杂志

Objective@#To characterize the gut microbial community structure of two-kidney-one-clip (2K1C) hypertensive rats, provide new evidences for prevention and treatment of hypertension.@*Methods@#Adult male SD rats were divided into 2K1C hypertensive model group and sham operation group (n=8 each). Blood pressure was recorded by tail-cuff technique weekly for 4 weeks. Then, the total fecal DNA of rats in 2K1C model group and sham operation group were extracted. The structure and principal components of intestinal flora in 2K1C model rats and sham operated rats were analyzed using Hiseq3000 sequencing platform. Additionally, real time fluorescent quantitative polymerase chain reaction technology was used to detect the content of predominant bacteria, including Escherichia, Bifidobacterium, Lactobacillus and Bacteroides.@*Results@#Compared with sham operation group, significant reduction in the relative abundance of Firmicutes (31.72 (30.06, 32.18) vs. 40.99 (38.78, 44.41), U=0.00, P<0.05) and increase in Bacteroidetes (48.13(41.16,50.25) vs. 27.81(25.84,31.38),U=0.00, P<0.05) were observed in the fecal samples from model group. The relative abundance of Escherichia coli (0.08(0.07,0.11) vs. 0.07(0.06,0.08),U=12.50, P<0.05) was increased and the short chain fatty acid producing strains such as Coprococcus, Roseburia, Blautia, Clostridium and Bacteroides was reduced in 2K1C model group than in sham operation group (all P<0.05). Moreover, the relative abundance of Prevotella (Bacteroidetes) was also significantly higher in 2K1C model group than in sham operation group (18.14(17.78,18.75) vs.1.83(1.50,5.19), U=0.00, P<0.05). Moreover, the relative abundance of Ruminococcus (Firmicutes) was significant higher in 2K1C model group than in sham operation group (7.73(6.04,9.34) vs. 3.68(2.46,4.67),U=0.00, P<0.05). Principal coordinate analysis showed that there was significant difference in the gut microbial community structure between 2K1C model group and sham operation group.@*Conclusion@#There are significant changes in the gut microbial community structure in 2K1C model group as compared to sham operation group, indicating renovascular hypertension might affect gut microbial community structure in this rat model.

Analysis of the current situation and influencing factors of regular spot check for CSSD cleaning quality / 中华医院管理杂志

Objective To investigate the regular spot check implementation of central sterile supply department(CSSD) at hospitals of all grades across China and analyze its influencing factors to provide the basis for further improvement of regular cleaning quality inspection. Methods Cross-sectional study was conducted form February to July of 2017,and 132 hospitals all over the country were selected to investigate with the questionnaire the current status of CSSD management model, staffing and regular cleaning quality inspection. Results The ratio of the nursing staff and the number of beds was 1.15:100,the ratio of staff and the number of beds was 2. 00:100. 81. 82% (n =108) of the hospitals adopted the centralized management model. The qualification rate for regular spot check execution was 87.12% (n=115). The results of multiple logistic regression showed that the centralized management model was more conducive to the regular spot check than the non-centralized management model (OR=4.71,95% CI:1.05-21.08). Conclusions The centralized management model proves positive for the implementation of regular spot checks;and CSSDs should pay more attention to the regular spot check of the cleaning quality.

Intravenous versus articular injection of tranexamic acid for reducing hemorrhage after unilateral total knee arthroplasty / 中国组织工程研究

BACKGROUND: The perioperative hemorrhage of knee surgeries is a difficulty in clinic, and the efficacy of tranexamic acid to reduce postoperative bleeding has attracted more attention, but choosing which administrations remains controversial. OBJECTIVE: To investigate the efficacy of tranexamic acid by intravenous injection or articular injection for reducing the perioperative hemorrhage of total knee arthroplasty. METHODS: Sixty patients undergoing unilateral total knee replacement were enrolled, and were then randomized into three groups (n=20 per group): no tranexamic acid administration (group A); intravenous dropping of 15 mg/kg tranexamic acid before tourniquet application plus 10 mg/kg tranexamic acid at 3 hours postoperatively (group B); articular injection of 50 mL saline diluted with 1 g tranexamic acid through a drainage tube (group C). Two-hour closure of drainage tube was performed in all patients. The postoperative dominant and hidden blood loss, blood transfusion rate, pulmonary embolism as well as lower extremity deep venous thrombosis were recorded. RESULTS AND CONCLUSION: (1) The dominant and hidden blood loss in the groups B and C were significantly less than those in the group A (P < 0.05); the dominant blood loss showed no significant difference between groups B and C (P > 0.05); the group B exhibited a significantly less hidden blood loss compared with group C (P < 0.05). (2) The blood transfusion rate in the groups B and C was significantly lower than that in the group A (P < 0.05). (3) No pulmonary embolism or lower extremity deep venous embolism occurred during 3-month follow-up. (4) That is to say, tranexamic acid can obviously reduce perioperative blood loss and blood transfusion rate without pulmonary embolism or lower extremity deep venous thrombosis, and intravenous administration exerts better clinical effectiveness.

A Survey on the status of contact lens cases hygiene compliance in the Orthokeratology Lens wearers / 中国实用护理杂志

Objective To investigate the current situation of contact lens cases′contamination and contact lens hygiene compliance in Wenzhou, so as to provide a basis for further improvement of hygiene for wearers. Methods The general data of the wearer and the present condition of the lens cases hygiene compliance were investigated by the questionnaire, and the contamination was judged by themicrobiological culture. Results The positive rate of bacterial culture in the contact lens cases was 43.96％(40/91). Compared with the positive culture group, the negative group performed better in hand hygiene (χ2=17.624, P<0.01), and the frequency of the case sterilization in the negative group (χ2=43.754, P<0.01), cleaning frequency (χ2=69.737, P<0.01) were higher than the positive group. In the choice of cleaning methods, the proportion of using brushing (χ2=65.441, P<0.01) and re-rinsing (χ2=59.663, P<0.01) in the negative group was higher than that of the positive group. The results were all statistically different.Conclusion The present condition of hygiene compliance of the orthokeratology lens wearers in Wenzhou is not so well, and it needs to be further improved. And agents, scrubbing, rinsing and drying are effective for reducing microbes.

Preparation of tadalafil-dapoxetine coamorphous complex with evaluation of dissolution and physical stability / 药学学报

Tadalafil (TD), a phosphodiesterase-5 inhibitor for the treatment of erectile dysfunction, has a low oral bioavailability due to its extremely poorly aqueous solubility. The aim of this study was to enhance its solubility and dissolution by coamorphization with dapoxetine (DP), a selective serotonin reuptake inhibitor to manage premature ejaculation. Coamorphous TD-DP (molar ratio, 1:1) was prepared by solvent-evaporation method and characterized by differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD) and Fourier transform infrared spectroscopy (FTIR). The supersaturated dissolution of TD from coamorphous TD-DP was investigated in various aqueous media and compared to that of crystalline TD. In addition, physical stability of coamorphous system was also evaluated under the conditions of 40℃/75% relative humidity (RH) and 25℃/60% RH for 90 days. DSC thermogram and PXRD pattern indicated the formation of the coamorphous TD-DP. In comparison to original TD crystal, the dissolution of TD from coamorphous system were significantly enhanced in various media (water, 0.01 mol·L-1 HCl and pH 4.5 phosphate buffer). In addition, no crystallization phenomenon of the prepared coamorphous system was observed until 90 days' storage under 25℃/60% RH. However, when temperature and humidity were increased to 40℃/75% RH, the coamorphous TD-DP was recrystallized easily.

Clinical analysis of pedicle screw fixation in the treatment of type Ⅱ odontoid fracture with bone grafting and non-bone grafting / 中国基层医药

Objective To explore the clinical efficacy of bone grafting in the treatment of type Ⅱ odontoid fracture with pedicle screw fixation .Methods Of 14 cases with type Ⅱ odontoid fractures ,8 patients in group A received pedicle screw,lamina autologous bone grafts,6 cases of group B received simple posterior pedicle screw fixation.The operative time ,the amount of surgical bleeding and the postoperative cervical spine flexion and rotationwere observed at 3 months postoperatively ,and the patients were followed up for 5-45 months.Results All patients were followed up for 5-45 months,with an average of 26.5 months.The operation time was (1.83 ±0.5) h in the bone graft group,and (1.58 ±0.9)h in the non-bone graft group,the difference was statistically significant (t=2.842,P>0.05).The blood loss of the bone graft group was (150 ±16)mL,which of the non-bone graft group was (120 ±14) mL,the difference between the two groups was statistically significant (t =3.57,P >0.05).After 3 months,the flexion of the cervical spine of the bone graft group was (31.2 ±4.6)°,which in the non -grafted group was (32.3 ±5.7)°,the difference was statistically significant (t=0.675,P<0.05).The rotation of the bone graft group was (40.6 ±4.5)°,which in the non -graft group was (41.3 ±3.5)°,the difference was statistically significant (t=0.278,P<0.05).Both two groups had no vertebral artery and spinal cord injury ,wound healing. During the follow-up period,the two groups of patients had a good reduction of cervical spine ,no internal fixation lossening,fracture,fracture healing well,group A bone graft fusion.Conclusion For this type of fracture,simple atlantoaxial pedicle screw fixation compared with autologous iliac bone graft fusion treatment ,can save the operation time,reduce the amount of bleeding .

Laparoscopic right hemihepatectomy following a standardized technique / 中华肝胆外科杂志

Objective To determine the clinical value of laparoscopic right hepatectomy (LRH) carried out following a standardized technique.Methods The medical records of 15 patients who underwent LRH at the First Affiliated Hospital of Soochow University were retrospectively reviewed.The perioperative indicators which included the operation duration,blood loss,tumor diameter,hospitalization duration and postoperative complications were analyzed.Results There was no conversion to open surgery.The operation duration was (251.1 ± 73.3) min.The resected tumor diameter was (8.5 ± 4.2) cm,the blood loss was (550.8 ± 343.6) ml,and the hospitalization duration was (10.2 ± 3.7) days.There was one patient who developed postoperative bile leakage.There was no other complication and there was no perioperative death.Conclusions The standardized technique of LRH was easy and effective.This technique shortened the operation duration and improved patient safety.

Current status of medical instrument cleaning in 127 hospitals in five coastal provinces or cities in China / 中华护理杂志

Objective To investigate the current situation of medical instrument cleaning in Central Sterile Supply Departments(CSSD),in order to identify problems and provide references for further improvements of equipment cleaning.Methods Questionnaire survey was adopted,data of 127 CSSDs in five coastal provinces or cities in China in 2017 were collected,and status of each link of medical instrument cleaning was analyzed.Results The allocation rate of ultrasonic cleaner and spray cleaner were 96.6％ and 78.7％,respectively;62.2％ of hospitals used tap water to pre-rinse,and 10.2％ used normal saline or sterile water to pre-rinse,11.0％ used tap water for finial rinsing;78.7％ of hospitals did not perform continuous humidification in transit,and 18.1％ of hospitals did not perform continuous humidification and their time of transit was more than 2 hours;66.9％ of CSSDs only used multi-enzyme detergent.More than half of the hospitals did not record time for manual rinsing/manual final rinsing.Conclusion The configuration of medical instrument cleaning equipment of 127 CSSDs is good.However,it is necessary to pay more attention to cleaning details.Specifications for instrument cleaning water should be established;continuous humidification during transportation of medical instruments should be promoted;cleaning methods and cleaning detergents should be selected reasonably;standardized rinsing should be enhanced to ensure quality of medical instrument cleaning.

Experimental Research of Effect and Mechanism of Liangxue Tongyu Recipe on Acute Cerebral Hemorrhage in Rats / 广州中医药大学学报

Objective To observe the effect and mechanism of extracts of Liangxue Tongyu Recipe(LTR) on acute cerebral hemorrhage rats. Methods Twelve SD rats were randomly divided into sham operation group, model group, LTR water-extract group and LTR alcohol-extract group. Rats of sham operation group were injected with 2μL of normal saline into the left caudate nucleus, and rats of the other groups were injected with 2μL (0.25 U/ μL) of type Ⅶ collagenase into the left caudate nucleus to induce the model of acute cerebral hemorrhage. And then the rats of LTR groups were given intra-gastric gavage of LTR water-extract or LTR alcohol-extract. At the end of the experiment, we observed the macroscopic features of rat brain, pathological changes in rat brain under microscope after HE staining, awake time, rectal temperature, neurobehavioral scores and serum-specific enolase (NSE) level. Results Rats except for the sham operation group had various degrees of right hemiplegia symptoms, and the symptoms became severest on the third day of experiment. LTR alcohol-extract group and water-extract group had an effect on improving neurobehavioral scores, shortening awake time, and decreasing rectal temperature and serum NSE level of model rats. Conclusion LTR alcohol-extract and water-extract can relieve acute cerebral hemorrhage induced by type Ⅶcollagenase .

Clinical safety and efficacy of shortened period of clopidogrel treatment after BuMA stent ;implantation in elderly coronary heart disease patients over 75 years old / 中国介入心脏病学杂志

Objective To evaluate the clinical efficacy and safety of domestic BuMA biodegradable drug eluting coronary stent in elderly coronary heart disease patients over 75 years old with shortened duration of clopidogrel treatment. Methods 100 elderly patients who received coronary angiography and PCI were included, and they were randomly divided into the observation group ( n=50, received oral clopidogrel for 9 months) and the control group (n=50, received oral clopidogrel for 12 months). The occurance of angina pectoris, AMI, bleeding events and the results of control angiography were compared between the two groups after 12 months of follow-up. Results All the 100 patients were followed up in 12 months after discharge. 4 patients ( 8. 0%) in the observation group and 3 patients ( 6. 0%) in the control group had recurrent angina. Control coronary angiography 12 months later showed no restenosis in the stents. There was no significant difference between the two groups in the recurrence of angina pectoris and coronary stent restenonsis. No acute myocardial infarction,cliniacl bleeding events and late stent thrombosis occurred in the two groups. Conclusions The application of the domestic BuMA biodegradable drug eluting stent for the treatment of coronary heart disease patients over 75 years old is safe and effective with shortened duration of clopidogel treatment.

Application study on regional infusion chemotherapy by celiac trunk during operation in advanced gastric cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility, safety and efficacy of intraoperative regional infusion chemotherapy by celiac trunk in advanced gastric cancer patients.</p><p><b>METHODS</b>One hundred and twenty-six patients with advanced gastric cancer(stageII(-III() were screened from database of Gastrointestinal Surgery Department of Taizhou People's Hospital between January 2008 and December 2010 who underwent R0 resection and D2 lymphadenectomy, received postoperative chemotherapy(XELOX or FOLFOX), and had complete follow-up data. They were divided into infusion chemotherapy group (65 cases) and control group (61 cases) according to regional infusion chemotherapy or not (fluorine 1 000 mg and cisplatin 60 mg). The side effects of chemotherapy, parameters related to the operation, long-term survival and relapse rate were compared between the two groups.</p><p><b>RESULTS</b>The baseline data between the two groups were comparable(all P>0.05). Postoperative III( and IIII( adverse reaction of chemotherapy was not significantly different between the two groups (P>0.05). The time of postoperative intestinal function recovery [(67.9±14.8) hours vs. (68.9±15.0) hours, t=-0.380, P=0.705), volume of postoperative 1-week drainage [(66.1±17.1) ml vs.(61.9±18.2) ml, t=1.478, P=0.142], recent morbidity of complications[55.4%(36/65) vs. 49.2%(30/61), χ=0.256, P=0.613], and the long-term morbidity of complications [16.9% (11/65) vs. 14.8% (9/61), χ=0.111, P=0.739] were all not significantly different between the two groups. The 3-year survival rate and 3-year relapse-free survival rate in infusion chemotherapy group were significantly higher than those in control group(58.4% vs. 37.7%, χ=5.382, P=0.020; 58.4% vs. 34.4%, χ=6.636, P=0.010).</p><p><b>CONCLUSION</b>Regional infusion chemotherapy by celiac trunk during operation for advanced gastric cancer patients is safe and feasible, and can reduce the risk of local recurrence and improve survival rate.</p>

Effect of P2Y12 Receptor Inhibitors on ACS patients with CYP2C19 medium-metabolized genotype / 实用医学杂志

Objective To evaluate the changes of platelet aggregation rate and short-term prognosis after the application of colopidgrel with booster doses or replaced by ticagrelor for ACS patients with CYP2C19 medium-metabolized genotype). Method A total of 302 patients with medium-metabolized genotype were randomly divided into colopidgrel group (75 mg/bid) and ticagrelor group (90 mg/bid). Patients in both groups accepted other conventional treatments of coronary heart disease and accompanied diseases. The platelet aggregation rates and platelet inhibition rates were observed before and after the treatment. The incidence of adverse events was followed up within 1 m. Results After one-week treatment, the platelet aggregation rates of the inducement with 5 μmol/L ADP had statistical significance between colopidgrel group and ticagrelor group ( P = 0 . 019 ) and the platelet inhibition rates had statistical significance difference between the two groups (P = 0.000). No severe adverse events occurred within one-month follow-up and 10 dyspnea patients were all in ticagrelor group. Conclusions Compared with booster doses of clopidogrel, ticagrelor presents obvious inhibitory effect on platelet of patients with medium-metabolized of ACS but it increases the incidence of dyspnea.